| NPI | 1346611159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 60167) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0002921) |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2015-10-19 |